A Third Solution • Hacker News Board

Re: A Third Solution

#521

Post by gremlinsinc » Sun, Apr 26, 2020, 6:42 AM UTC

sandworm101 wrote: post #233

gremlinsinc wrote: post #145

Earlier quoted context omitted.

Can you be sure it's not an existential threat? Can you guarantee that a healthy person who gets this 3 times doesn't have a 100% fatality rate (i.e. it gets worse each time?) Can you guarantee asymptomatic people don't become sterile? (Not saying they do, but if they did this would be an existential crisis and lead to our extinction after a generation). Can you guarantee asymptomatic people still won't have lung dam…

>> (some asymptomatics athletic types have shown severe decline in lung abilities following covid19) Which is 100% normal for any pneumonia. I myself once had a bad lung infection (on my back for over a week). It took months before I could swim laps as fast as I did before. That's not anything special. Infections always have secondary medium-to-long term impacts.

Did you have trouble breathing when you had the pneumonia? These are cases of people with 0 or low # of symptoms, and only knew they tested positive of the virus. I'd imagine they just didn't realize they were sick, and then they eventually start feeling fatigue and run down when doing 'normal' things even after the virus passing their system.

ACE2 is in high concentration in the testes too, could this cause fertility issues? Sure it'd be good for the environment but a lot of couples really do want and enjoy their children or to have some someday.

It'd be nice to know as much as possible before we open the flood gates.

Re: A Third Solution

#522

Post by vinay427 » Sun, Apr 26, 2020, 7:10 AM UTC

kebman wrote: post #387

TenJack wrote: post #286

Earlier quoted context omitted.

I gathered the same thing. Basically the gist is, if we can develop a cheap, fast, and effective test for COVID-19 then we can test everywhere and re-open everything.

Is this what you're looking for? Scientists at NTNU St. Olav's Hospital has made a test that can check 150,000 patients per week for Corona infection [1]. (Yes, it's the same uni that used the USA as an example in warning students abroad against poorly developed health systems lol.) Already testing is a lot more frequent in Norway because of it, and they're cautiously re-opening some businesses and services, the firs…

The relevant quote actually concerned the collective infrastructure in the US, including health insurance. The actual quality of care in the US is great, particarly for specialty cases... for the few that can comfortably pay for it.

Relevant part of their tweet:

"This applies if you are staying in a country with poorly developed health services and infrastructure and/or collective infrastructure, for example the USA. The same applies if you do not have health insurance."

As well as a message, now apparently removed but archived by others, on their website:

"This also applies for countries with poorly developed collective infrastructure, for example the USA, where it can be difficult to get transport to the airport if you don’t have a car. The same applies if you don’t have health insurance."

Re: A Third Solution

#523

Post by apatters » Sun, Apr 26, 2020, 8:01 AM UTC

dustinmoris wrote: post #453

apatters wrote: post #446

Earlier quoted context omitted.

The author doesn't understand the virus and makes many dubious statements about it. > Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead. This is a poor analogy. In Russian roulette you have a 1 in 6 chance of getting a bullet in the head. The overall infection fatality rate of COVID-19 is under 1%, and the vast majority of fatalities are people w…

There is too much sense and logic and critical thinking in your response. Brace yourself for the backlash! :)

Thanks! No witch hunts yet, but I don't think a lot of people saw the comment.

At the outset of the infection surge and subsequent lockdowns I was saying stuff like this and being crucified for it. We should have followed the Korean model from day one and in the US its existence was almost totally ignored. I have continued to say all these things and over time the lynch mobs seem to be dissipating. Hopefully we will see more level-headed critical thinking as the next step, which will lead to solutions.

Re: A Third Solution

#524

Post by DominikD » Sun, Apr 26, 2020, 12:23 PM UTC

buboard wrote: post #509

DominikD wrote: post #508

I'm tired of reading that it spreads through the air and so we should avoid indoor spaces where we share air. It spreads through droplets large enough for the gravity to pull them down relatively fast. It's not measles, you can't contract it by breathing the same air someone infected did unless you're in a medical setting and AGP is performed on someone who's infected. If it was airborne, masks that aren't fitted wou…

How sure are we? https://www.sciencedirect.com/science/article/pii/S016041202...

All studies that point to it being airborne are from medical setting or are misrepresented in the media. For example there's a new one that circulates abbreviated to "air conditioned restaurants make SARS-CoV-19 airborne".

Comment + source: https://twitter.com/alicesim/status/1254057546333241346

As for your source: it misrepresents SARS as airborne in the same way most other publications of this ilk do: by taking examples from medical setting and extrapolating from that. It even admits the setting but keeps the general "airborne" label for the sake of argument.

> SARS-CoV-1, did spread in the air. This was reported in several studies and retrospectively explained the pathway of transmission in Hong Kong’s Prince of Wales Hospital

Yes, this virus can become airborne if aerosol generating procedure is performed on an infected patient. But 1) you don't intubate people in restaurants, and 2) that's why PPE is so important for medical staff, because they do operate in conditions in which this virus can become airborne. That's also why you can't visit people in hospitals any more.

You can't do contact tracing of airborne infection that is this contagious. Measles hover in the room for hours after spraying and you can't trace down everyone who was doing groceries across 5h in your local market (I'm glad we have vaccine for measles). But you can do tracking and isolation of SARS-CoV-19 patients. Why? Because droplets are pulled down to surfaces and are no longer dangerous within seconds to minutes after spraying. But they do stay on surfaces, that's why hand hygiene is so important.

Re: A Third Solution

#525

Post by gdilla » Sun, Apr 26, 2020, 3:56 PM UTC

_ph_ wrote: post #425

mcherm wrote: post #90

Earlier quoted context omitted.

> I have not found any mainstream sources that advocate screening everyone every day That's because we currently aren't capable of testing everyone who is obviously sick just once. If we got there, we wouldn't even be close to being capable of testing key personnel (like health care workers). If we got there we wouldn't even be close to being able to test everyone once. If we got there we wouldn't even be close to be…

The concept for restarting the German football league involves daily testing of all players. So the idea is indeed widespread, but often enough just impractical for the numbers of tests required. Testing a few hundred people daily would be doable, as Germany has relatively good testing capacity - probably one main reason for the overall better handling of the pandemic so far. But the concept still gets critisized, as…

I would expect where there's a large enough economic incentive, and wealthy-enough private group (say, the NFL, MLB, etc) who wouldn't need to wait for government policy or supply, we will see daily testing of their 'employees' so that they can get back to operating. May not be any fans in a live setting, but better than nothing.

Re: A Third Solution

#526

Post by JoeAltmaier » Sun, Apr 26, 2020, 4:06 PM UTC

marcell wrote: post #511

astrophysician wrote: post #318

Earlier quoted context omitted.

Again, you realize debating the true value of the fatality rate is a bit silly when we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) if we hadn’t and don’t continue to manage this with severe measures? Do you agree with that statement? It doesn’t matter what the incremental mortality rate is. It doesn’t matter. We don’t know the true fatality rate, yes, but we do know it’s…

> we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) This isn't really true. It depends a lot on the state. The healthcare system in my area, California Bay Area, is completely underwhelmed. Here are some numbers from San Mateo: (1) 40% of standard ICU beds are open (2) 91% of ventilators are unused (3) 91% of "surge beds" are unused Source: https://www.smchealth.org/post/san…

This changes in a day, if the lockdown were lifted. The number of needed ventilators etc could grow 10X in no time.

Those numbers reflect a correct, working response. Sure the restrictions can be lifted, but carefully and balanced by changes in those stats.

Re: A Third Solution

#527

Post by astrophysician » Sun, Apr 26, 2020, 4:21 PM UTC

marcell wrote: post #511

astrophysician wrote: post #318

Earlier quoted context omitted.

Again, you realize debating the true value of the fatality rate is a bit silly when we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) if we hadn’t and don’t continue to manage this with severe measures? Do you agree with that statement? It doesn’t matter what the incremental mortality rate is. It doesn’t matter. We don’t know the true fatality rate, yes, but we do know it’s…

> we already know healthcare systems will be overwhelmed (and have been overwhelmed already!!) This isn't really true. It depends a lot on the state. The healthcare system in my area, California Bay Area, is completely underwhelmed. Here are some numbers from San Mateo: (1) 40% of standard ICU beds are open (2) 91% of ventilators are unused (3) 91% of "surge beds" are unused Source: https://www.smchealth.org/post/san…

> If our goal is to flatten the curve to slightly below hospital capacity, current policy has flattened the curve way too much.

Our goal is to simply avoid hospitals becoming inundated. How would it be possible to flatten the curve to "slightly below hospital capacity"? To do that we would need to know exact numbers on hospitalization rates from infections, have a testing capability that is far beyond what we currently can do, and then we would need to have fine-tuned control on peoples' behaviors and also never be wrong. We have too much ignorance about too many things to do this in a way that you would deem optimal. This is a disease that takes a median of 5 days to incubate, so as soon as we get something wrong (hint: we will get it wrong), it festers for 5 entire days before we know it, and then we're stuck with the consequences. The only rational choice is to take severe action and hope it's enough. It wasn't enough in Italy, it wasn't enough in NYC.

If you're saying that social distancing/lockdown policies are an "overreaction" because we still have ICU beds and ventilators, I think that's a pretty good sign. The entire point is to do something drastic now, and gradually ease distancing measures as it becomes safe to do so without causing additional large-scale outbreaks. As soon as we have the ability to contact-trace all new infections and can successfully contain outbreaks, we can start letting up.

Re: A Third Solution

#528

Post by concordDance » Sun, Apr 26, 2020, 6:32 PM UTC

sfink wrote: post #506

concordDance wrote: post #488

Earlier quoted context omitted.

Testing isn't the only way. Some people just advocate for isolating the elderly and having everyone else mingle. The life expectancy loss from just letting it run its course would be less than a tenth of the life expectancy difference between the second and third wealth quartiles in the USA. And if we aren't worried about that difference, then why are we imposing a quality of life reduction that's much larger than th…

(I'm no epidemiologist etc.) Because that's a terrible idea that doesn't make any sense. I understand the logic and why it's tempting, and I've even read some of the evidence supposedly backing it up. I find it thoroughly unconvincing. I won't address the moral side, just the practical. The virus disproportionately effects the elderly, yes, but far from exclusively. We have seen the non-elderly death rates with dista…

The idea would be to isolate the vulnerable and let everyone else get it.

As a society we have shown time and time again that we only care about "disasters", not the continuous but far greater and less expensively solved losses. Nuclear power vs coal, air plane accidents vs car accidents, the life expectancy reduction of poverty vs COVID-19...

Re: A Third Solution

#529

Post by timr » Mon, Apr 27, 2020, 2:15 AM UTC

selimthegrim wrote: post #518

timr wrote: post #348

Earlier quoted context omitted.

Cite something -- anything -- legitimate that points long-term organ damage in young, otherwise healthy people. Newspaper anecdotes don't count. All evidence so far is that a small fraction of people sick enough to be in the ICU end up with some sort of non-lung organ involvement. The vast majority (>99.98%) of young ( https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi...

https://www.washingtonpost.com/health/2020/04/24/strokes-cor... (TL, DR: NEJM next week)

Right. So a day after you make your comment implying lots of young people are experiencing long-term organ damage, the WaPo discusses an as-yet-unpublished paper discussing a small number of stroke victims who may or may not have been influenced by this virus.

If this is the best you can do, you're grasping at straws.

Re: A Third Solution

#530

Post by skosuri » Mon, Apr 27, 2020, 3:13 PM UTC

new299 wrote: post #305

predxionbio wrote: post #295

Earlier quoted context omitted.

I'm not familiar with the acronym PSM. Can you expand? Are you familiar with the work of Dr. Chui at UCSF? His group has done some really cool work using mNGS to detect/diagnose emerging/rare infections in critically-ill patients with refractory encephalopathy

Sorry, typo. I meant SPR (surface plasmon resonance). I’ve worked at a number of NGS platform companies developing new sequencing approaches. The problem is that sequencing is still expensive at the per-run level. It’s possible to be cost competitive with qPCR if you multiplex samples. But this isn’t ideal. It would be interesting to create a small/cheap sequencer which could be applied to point-of-care/at-home testi…

We've developed something NGS-based we call SwabSeq. You can find out more here: https://www.notion.so/Octant-SwabSeq-Testing-9eb80e793d7e463...

You can get to $1/sample; but need >1000 samples/run at least to get to that cost level. Could run 10k/day without automation; likely a lot more (100k-1MM) with automation.